幽門側胃切除術後に発症した脾腫瘍に対し拡大視効果で残胃血流を温存しえた腹腔鏡下脾臓摘出術の1例

Laparoscopic splenectomy for preserving blood flow of the gastric remnant after distal gastrectomy utilizing the magnified view of the laparoscope : report of a case

◆要旨：患者は79歳，男性の慢性C型肝炎患者．胃癌に対する開腹下幽門側胃切除術の既往がある．肝癌スクリーニングのCTで脾腫瘍を指摘され，同病変はFDG-PETで高集積像を認めた．脾原発悪性リンパ腫が疑われ，診断と治療の目的で腹腔鏡下に脾摘術を行う方針となった．幽門側胃切除術に脾摘を加えた場合，残胃の血行障害をきたす可能性があり，術前に後胃動脈と短胃動脈の走行を評価し，腹腔鏡による拡大視効果の下，脾動脈から分岐する後胃動脈と短胃動脈の一部を温存して脾摘を行った．術後の造影CTで残胃血流は温存されており，合併症なく退院した．幽門側胃切除術後の腹腔鏡下脾摘術は過去に報告が見られず，本報告が第一報と思われた．

We present a case in which laparoscopic total splenectomy was performed to ressect a splenic tumor after open distal gastrectomy for gastric cancer 9 years ago. The patient was a 79-year-old man with chronic hepatitis C. A splenic tumor of the 24mm size was pointed out in CT scan for screening of liver tumors, and the lesion showed high accumulation in FDG-PET suggesting malignant lymphoma of the spleen. Laparoscopic splenectomy was performed for the purpose of diagnosis and treatment, while splenectomy in patients with distal gastrectomy may cause severe ischemia of gastric remnant. Before surgery, the position of posterior gastric and short gastric arteries were identified by MD-CT, and these vessels were carefully preserved under the magnified view of laparoscopic surgery. His postoperative course was uneventful without gastric ischemia. This may be the first report of laparoscopic splenectomy in a patient after distal gastrectomy.